血脂水平对恩氟烷吸入后肺摄取含量的影响

Effect of serum lipid level on pulmonary uptake after inhalation of Enflurane

目的探讨血脂水平对恩氟烷吸入后肺摄取含量的影响。方法回顾性选取2016年1月至2017年12月于邢台市人民医院接受择期全身麻醉手术的151例患者,根据术前血脂水平分为观察组(合并高脂血症,n=53)和对照组(未合并高脂血症,n=98)。所有患者入室后采用丙泊酚1~2 mg/kg、芬太尼3μg/kg、咪达唑仑0.05~0.100 mg/kg进行麻醉诱导,待患者意识消失后行气管插管和机械通气,启动恩氟烷挥发罐(吸入浓度:2%、氧流量2 L/min),记录所有患者在吸入恩氟烷后1 min(T_1)、4 min(T_2)、8 min(T_3)、20 min(T_4)、40 min(T_5)时的吸入浓度(Fi)与呼出浓度(Fe)计算两者的比值以及该比值达滴度值(Fe/Fi=0.8)所需要的时间。结果吸入恩氟烷后,两组患者的Fe/Fi比值均逐渐升高,T_2~T_5时刻的Fe/Fi比值均显著高于T1时刻,差异具有统计学意义(P<0.05)。组间比较,观察组T_2和T_3时刻的Fe/Fi比值均显著低于对照组,差异具有统计学意义(P<0.05),而两组患者的T_1、T_4、T_5时刻的Fe/Fi比值比较,差异均无统计学意义(P>0.05)。观察组患者的Fe/Fi比值达到0.8所需要的时间显著长于对照组,差异具有统计学意义(P<0.05)。结论高脂血症能增加恩氟烷吸入后短期内的肺摄取量,可能与其血气分配系数升高有关。

Objective To explore the predictive value of serum lipid level on pulmonary uptake after inhalation of enflurane. Methods A retrospective study of 151 patients undergoing elective general anesthesia in this hospital during January 2016 to December 2017 were enrolled in this study and they were divided into observation group （with hyperlipidemia, n=53） and normal UA group （without hyperlipidemia, n=98） according to the preoperative blood lipid level. All cases received anesthesia after entering the room, they were induced with propofol 1～2 mg/kg, pentanyl 3 μg/kg and Midazolam 0.05～0.100 mg/kg, then given with endotracheal intubation and mechanical ventilation after lost consciousness. Then starting the enflurane vaporizer （inhalation witth concentration： 2%, oxygen flow rate 2 L/min, and the inspired concentrations （Fi） and expired concentrations （Fe） of sevoflurane were recorded at 1 min （T 1）, 4 min （T 2）, 8 min （T 3）, 20 min （T 4） and 40 min （T 5） of inhalation were recorded to calculate the ratio of Fe/Fi and time spent in reaching the titration value （Fe/Fi =0.8） in these two groups. Results After inhalation of enflurane, the Fe/Fi ratio was gradually increased in these two groups, and the Fe/Fi ratio at the time of T 2 to T 5 were significantly higher than that at the time of T 1 （ P 〈0.05）. The Fe/Fi ratio at the time of T 2 and T 3 in observation group were significantly lower than those in control group （ P 〈0.05）, and there was no significant differences in Fe/Fi ratio at the time of T 1, T 4 and T 5 between these two groups （ P 〉0.05）. The time spent in reaching 0.8 of Fe/Fi ratio in observation group was significantly longer than that in control group （ P 〈0.05）. Conclusion Hyperlipidemia can increase the pulmonary uptake in the short term after inhalation of halothane, which may be related to the increase of blood-gas partition coefficient.